A new, simple, and accurate method for non-invasive estimation of pulmonary arterial pressure

Abstract

Objective: To develop and validate a new non-invasive method for the estimation of pulmonary arterial pressure (PAP) based on advanced signal processing of the second heart sound. Design: Prospective comparative study. Setting: Referral cardiology centre. Patients: This method was first tested in 16 pigs with experimentally induced pulmonary hypertension and then in 23 patients undergoing pulmonary artery catheterisation. Methods: The heart sounds were recorded at the surface of the thorax using a microphone connected to a personal computer. The splitting time interval between the aortic and the pulmonary components of the second heart sound was measured using a computer assisted spectral dechirping method and was normalised for heart rate. Results: The systolic PAP varied between 14-73 mm Hg in pigs and between 20-70 mm Hg in patients. The normalised splitting interval was measurable in 97% of the recordings made in pigs and 91% of the recordings made in patients. There was a strong relation between the normalised splitting interval and the systolic PAP (pigs: r = 0.94, standard error of the estimate (SEE) = 5.3 mm Hg; patients: r = 0.84, SEE = 7.8 mm Hg) or the mean pulmonary pressure (pigs: r = 0.94, SEE = 4.1 mm Hg; patients: r = 0.85, SEE = 5.8 mm Hg). Conclusions: This study shows that this new non-invasive method based on advanced signal processing of the second heart sound provides an accurate estimation of the PAP.